Abstract:
Background: Unsafe abortions are the third most important cause of maternal mortality in India. This is despite steps taken by the government and abortions being legal for a broad range of indications since 1971. Several amendments are made in the medical termination of pregnancy act, 1971, including legalisation of medical method of abortion (MMA) to reduce mortality due to unsafe abortions. However, India could not reap full benefits of MMA because of irrational use of medical abortion pills (MAPs) and MMA continues to contribute to unsafe abortions and wide spread complications among abortion seeking women. Objective: To identify, describe and analyse the gaps in rational use of medical abortion pills in India. Study Method: Literature review of relevant articles related to medical method of abortion and usage of medical abortion pills. Results and Discussion: Irrational use of medical abortion pills due to non-availability of MA pills at public health care facilities, unregulated over-the-counter sale of MAPs, low level of knowledge of providers (prescribers and dispensers) and end users (abortion seeking women) made MMA a contributor to unsafe abortions. The private providers were not forthcoming in registering their facilities because of governance issues. Overburdened public facilities and high cost of scarcely available private facilities pushed poor rural women to avail services from unqualified health professionals. As a consequence, MAPs, are being prescribed, dispensed and utilised in irrational ways contributing to complications of medical abortions. Conclusions and Recommendations: To overcome these gaps there is a need to put emphasis on dissemination of information regarding MMA, ensured availability of MAPs at all public facilities, regularising the sale of MAPs, training of prescribers and dispensers, to amend the MTP Act to include nurses and Indian traditional medicine i.e. Ayurveda, Yoga and Naturopathy, Unani, Sidha and Homeopathy (AYUSH) practitioners as certified medical abortion providers and to augment the capacity of district functionaries to facilitate the process of registering the private facilities for abortions.